Pneumococcal Disease: Clinical Guidance on Prevention, Diagnosis and Treatment

A summary of CDC's clinical guidance for healthcare providers.

Streptococcus pneumoniae is a common bacterial cause of acute otitis media, sinusitis, community-acquired pneumonia and bacterial meningitis. Vaccines are recommended to prevent it, and treatment guidelines vary by syndrome.

Prevention

• Vaccination is the best way to prevent pneumococcal disease; see CDC's pneumococcal vaccine recommendations.
• The PneumoRecs VaxAdvisor mobile app helps vaccination providers work out quickly which pneumococcal vaccines a patient needs, and when.

Chemoprophylaxis

CDC has no guidance on antibiotic prophylaxis for close contacts of people with pneumococcal disease; secondary cases of invasive infection are uncommon.

Children without a working spleen are the exception. The American Academy of Pediatrics generally recommends daily oral penicillin V for children with functional or anatomic asplenia, including those with sickle cell disease. In general, clinicians should consider prophylaxis for all children with asplenia under 5, continuing for at least a year after splenectomy — alongside vaccination.

Diagnosis

• A definitive diagnosis generally rests on isolating the organism from blood or another normally sterile site.
• Tests can also detect the capsular polysaccharide antigen in body fluids, and nucleic acid amplification tests (NAAT) offer molecular detection.
• A commercial urinary antigen test detects the C-polysaccharide antigen of S. pneumoniae as a cause of community-acquired pneumonia. It is rapid and simple, reasonably specific in adults, and can detect pneumococcal pneumonia even after antibiotics have started.

Treatment

Guidelines vary by syndrome — see guidance on pneumonia and on common illnesses in adults and children.

For serious infections, treatment usually starts with broad-spectrum antibiotics; once susceptibility testing is done, clinicians may switch to a more targeted, narrow-spectrum antibiotic.

Sources

• Centers for Disease Control and Prevention, "Clinical Guidance for Pneumococcal Disease." https://www.cdc.gov/pneumococcal/hcp/clinical-guidance/index.html
• Further reading: the pneumococcal chapters of CDC's Pink Book and the American Academy of Pediatrics' Red Book.
• Words on this page from people and organisations outside the federal government are paraphrased; rewritten in hubnx's own words.